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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700945
Report Date: 01/04/2024
Date Signed: 01/04/2024 03:23:23 PM

Document Has Been Signed on 01/04/2024 03:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WELLCARE HOMES 3FACILITY NUMBER:
342700945
ADMINISTRATOR:REYNELIZA U CAMALIGFACILITY TYPE:
737
ADDRESS:10799 SIMMERHORN RD.TELEPHONE:
(916) 639-0091
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 4CENSUS: 4DATE:
01/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Reyneliza Camalig, Yvonne CamaligTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility to conduct a case management visit. Facility staff Yvonne Camlig explained to LPA Valerio that he would like guidance regarding compliance of Title 22 regulations with HCBS guidelines. LPA met with Previous Administrator Yvonne Camalig, Current Administrator Reyneliza U Camalig, and Program Manager Chris Wingate.

The facility is an Enhanced Behavioral Support Home funded by Alta California Regional Center. The facility is licensed to serve four (4) adults 18 to 59 years of age, of which two (2) residents may be considered non-ambulatory. LPA observed 7 staff on shift.

LPA toured the physical plant with previous administrator Yvonne Camlig. LPA observed the garage, which was in question for HCBS Final Rule and Title 22. LPA observed the garage to have emergency supplies, storage items with seasonal supplies, locked cabinets filled with cleaning supplies and sharps, an extra refrigerator, and staff lockers. Toxins, cleaning supplies, and sharps were locked and inaccessible to residents in care. According to facility staff, they have separate supplies located inside the home for resident use. When residents request items, such as laundry detergent or cleaning supplies, the resident may have access with the assistance from staff.

LPA obtained resident files from previous administrator Yvonne Camalig. LPA spoke to management staff regarding resident needs, behaviors, and safety plans. LPA has determined that the facility is within compliance of regulations. No health, safety, or personal rights risk were observed during today's visit.

Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed.

An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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